What does the statistic of zero new deaths reported on Monday mean for Ireland?
If Ireland avoids a second coronavirus peak, Monday, May 25th, 2020 will be remembered as a highly significant day; no Covid-19 deaths recorded, the first time no one succumbed to coronavirus in 66 days.
In between, we negotiated the first peak and the brutal loss of more than 1,600 lives – there have been more deaths since but unquestionably a new stage has been reached.
The State's chief medical officer, Dr Tony Holohan, calmly declared that the declining number of new cases and reported deaths over the previous week showed "we have suppressed Covid-19 as a country".
HSE chief clinical officer Dr Colm Henry was more animated; Covid-19 has been "beaten off the streets of our towns and cities and into households" and "virtually extinguished".
That curve was flattened; hospitals and especially their ICUs were not overwhelmed and – so far – Ireland has fared better than most countries when reliable mortality rates are factored in.
So can we all relax now?
No. The novel virus is still out there, and there is no vaccine and or widely available treatment. That is why most infectious diseases specialists remain uneasy – many advocate slower easing of restrictions, retaining a crush approach as a means to a quicker return to normality, rather than faster opening up with ongoing containment.
Trinity College virologist Dr Kim Roberts warns: "We have to remember how quickly it goes from being an isolated infection to an outbreak that is overwhelming a healthcare system . . . only a matter of weeks."
Prof Liam Glynn of the University of Limerick, who has provided a daily snapshot analysis of trends on Twitter, is in no doubt "a major milestone has been reached".
In the absence of a vaccine and effective treatments, “our greatest weapon [against Covid-19] is everybody, and how they act”, he adds. That means continuing to deploy those drilled-in measures including wearing face masks in public, combined with rigorous testing, tracing and isolation to pick up any re-appearance.
“That is about how we manage the new normal; how we live and social distance. We should not be satisfied with 10-15 cases. It’s much better if we have no cases – get to zero. Then we are in a better position to decide our future.”
What are the latest developments on new vaccines?
More than 120 potential vaccines are in development, but less than a dozen are heading the race, having made it to human trials stage. Many are performing well in animals but that's no guarantee of success.
The speed of development is unprecedented. Big alliances between research institutions and pharma giants are being forged – there is a remarkable sharing of data.
Most attention is on US biotech company Moderna – the first coronavirus vaccine to be tested in humans – and a vaccine being developed in Oxford University. They may, within months, have enough evidence behind them for it to be administered on an emergency-use basis.
Unlike traditional vaccines, which contain a weakened version of the actual virus or portions of it, Moderna’s vaccine is based on taking genetic material from the virus and delivering it to healthy cells.
The Oxford vaccine is a weakened version of a common cold virus (adenovirus) that causes infections in chimpanzees, that has been genetically changed so it is impossible for it to grow in humans.
It was fast-tracked because the research team had already tested similar vaccines in humans for other viruses, including Mers and Ebola.
It is of particular interest because it promotes an immune response at several levels, according to Kim Roberts. The reason vaccines for Mers and Sars – “cousin viruses” to Covid-19 – never materialised was down to finance. This time “the need is great and money is being provided”.
Roberts says a range of vaccines may emerge with different levels of effectiveness in reducing symptoms and transmission.
Does recent news mean a vaccine could become available sooner than previously thought?
The global effort may be awesome but vaccine development is fraught with uncertainties. No vaccine is 100 per cent effective, and the vast majority of candidates that make it to clinical trials do not succeed in getting to market.
Initially, the Oxford vaccine was said to have an 80 per cent chance of success. At one point, the British government said 30 million vaccine doses could be available across the UK by September.
Last weekend a leading member of its team, Irish scientist Prof Adrian Hill, said there was only a 50 per cent chance of it working because UK cases are declining so fast. There may not be enough people to test it on. “We’re in the bizarre position of wanting Covid to stay, at least for a little while.”
Roberts brings it all back to: “Wait and see the clinical trial outcomes.” She believes a vaccine will emerge. “When, I don’t know. I don’t think it will be in a year.”
Scientists are attempting to find ethically acceptable ways of speeding up timelines. Some are considering unconventional ways to speed up the process by injecting healthy adults with live coronavirus. Normally, it would never be considered to test a deadly virus for which there is no cure, but these are extraordinary times.
The other big uncertainty is lasting immunity or not, once a person is infected. Most people who recover from Covid-19 do not make many killer antibodies against the virus.
If an effective vaccine materialises, all changes; but no one can assume vaccination will save us.
What other treatments are being worked on?
A range of potential treatments are at clinical trial stage, ranging from new "antivirals", re-purposed drugs, and even the BCG vaccine, known to boost immunity beyond TB. Many are testing drug combinations.
Early data shows remdesivir, developed for use against Ebola, could shorten recovery time. It is being fast-tracked for wider use in the US and EU.
Meanwhile, the WHO has suspended tests on the malaria drug hydroxychloroquine because of safety concerns.
Attracting growing attention is interferon (a protein released by cells in response to an invading virus) in helping people with mild Covid-19 infection.
Innovations at the medical coalface through deployment of digital technology and new protocols in looking after those who are hospitalised with Covid are already ensuring better patient outcomes.
Roberts believes a cure is unlikely because of rapid on-set of acute infection, but a drug that shortens infection duration and reduces chances of ending up in hospital is realisable.
Where are we on quick diagnostic tests and antibody tests?
Development of rapid tests for diagnosis of Covid, and antibody tests that confirm someone has been infected, is continuing apace.
Some new diagnostic and antibody tests can produce results in 15 minutes. Speed will be critical to countering flare-ups. But so are reliability and validation; does the test have a high degree of specificity and low rate of false readings? Too many were rushed to market and failed to meet that standard.
A mix of easily deployed diagnostic (PCR) tests, and blood tests to confirm presence of Covid antibodies are needed, Liam Glynn says. “As we open up, having information on who has immunity is crucial.”
Will on/off lockdowns be with us for years, given too many unknowns?
The absence of a vaccine is a big over-riding factor forcing the world to put up with coronavirus. Suppressing it as successfully as possible in the meantime enables a country to live closest to pre-Covid normality.
If a vaccine protects for only a year, the virus will be with us for some time. If the virus is genetically unstable like the flu and mutates a lot, vaccine developers will need new formulations regularly.
Some believe the cost of getting rid of the virus is far too high, that infections, hospitalisations and deaths are worth the price, if we could just get back to work.
This means, according to Prof Anthony Staines of DCU, "Covid-19 becomes part of all our lives, like a nastier, and more lethal version of flu, with periodic serious outbreaks, regular infections, continuing deaths, and a radically changed social and employment environment into the indefinite future". It comes with big costs in running public transport, childcare and for the HSE itself.
He is in the crush-the-curve rather than merely flatten it camp. That requires a push to zero cases/deaths through quarantine, ramped up testing and tracing, and wearing masks in public.
So schools should remain closed till September, which provides a window of opportunity because it entails a lot less movement. That time should be used to risk-assess each element of the economy. It will probably mean a slower lifting of restrictions.
The ultimate aim is “we get out at the end of September with no cases, and then we can go back to more or less normal life”.
So GAA pitches are "damn close to zero risk"; changing rooms, bars and clubhouses are not. A busy beach in Florida with obvious distancing is okay; a crowded swimming pool with partygoers in North Carolina is not. No-Nos are: close contact; poor ventilation; and cold temperatures.
We should be South Korea, Staines adds. It had an outbreak at a nightclub since coming out of lockdown but moved swiftly and most people are going to work and schools are open.
Being realistic, he accepts someone will fly from London to Belfast and cause an outbreak in Cahersiveen, that will necessitate swift action, testing a lot of people and closing the town "for a week or three".
On a second peak, he fears the economy will open up too quickly, “it will come back and we will have to do it all again”. This time round, so many small businesses will have no chance.
Persisting with the coping approach means long-term restrictions on vulnerable people, and on nursing homes. It means continued social distancing at work, in social life, in public transport – and impairs the ability to have a real economic recovery. “The best shot is to bring coronavirus to zero.”
